The United States government, for all its exasperating foibles and silliness, retains the capacity to surprise and even delight. Five years ago, who could have guessed that we would elect a centrist African-American president with a middle name of Hussein. Three years ago, who could have guessed that our deeply divided Congress would pass ambitious (albeit imperfect) legislation that moved us toward universal insurance, promoted healthcare quality, safety, and efficiency, and banned the worst offenses of the private insurance market… all in the midst of the most painful economic meltdown in a generation. And just yesterday, who could have guessed that this Supreme Court would uphold this law in a principled decision that largely steered clear of today’s puerile politics. The pundits and bloviators will have a field day dissecting what today’s ruling will mean in the “who’s up, who’s down” echo chamber that passes for news. For now, I can’t help but recall Churchill’s famous line about our national character: “Americans can always be counted on to do the right thing… after they have exhausted all other possibilities.” Today, the Supreme Court – and particularly the Chief Justice – gave life to Churchill’s words.

15 Responses to “Today’s Supreme Court Decision: My Two Cents”

Great summary and accurate views. Most of the comments i’m looking at here are way off the mark! How can your comments be so vilified? Very disappointing! keep up the good work and smart analysis and commentary.

You may be offering false reassurance to a patient with lung cancer. Antibiotics may be working because they also have pneumonia. The real problem comes when the new President comes in this fall. I have been alive much longer than you have young man, to know that not enough problems exist yet for America to do the right thing. The only reason we went to war was because Canada couldn’t help. When I can go across the border and get better care, most Americans will, even those who play baseball.

You are an idiot, who has no idea what you are talking about. God forbid you live for another 20 years and suffer from a chronic or disabling disease… the death panels will deem you unworthy to live, because the funding is not available, and since you longer contribute to society you become unnecessary. Who then will pay for your care, all of the illegal immigrants who come to the United States and get healthcare for free, and can’t be taxed under the mandate?

About the decision, it should be decided on law not on politics. I don’t like the way that it went but I am not ready to criticize the decision. On the other hand, Obamacare is a horrible intrusion on a free people. Government should not be involved in health care or health insurance.

The fundamental premise is that health care is now a right and I ask you, who thinks that the government shouldn’t be involved in health care or health insurance, to please explain how is it that we have all been paying for the uninsured despite megalith insurance and corporate controlled health care facilities. Now, the insurance companies have to learn to manage risk and not just cherry pick who they want to insure. Let’s just say you develop diabetes and your health insurer wants to drop you – God help you. Now, they can’t do that whether you live in New York City or Oshkosh, Wisconsin.

I appreciate that the law is not perfect. It would be impossible to craft such legislation. We now have the opportunity to see what works and what doesn’t and fine tune it through regulation.

Conservatives will say that Robert’s did the wrong thing, but his reasoning was principled and, yes, gave great deference to the legislative body, and did not decide it along partisan ground.

Summarizes my feelings, almost to a ‘T’. This is not the end of the process, but does give faith that, however muddled, progress continues! And that some folks from different political perspectives still favor the rule of law…

I really enjoyed reading your blog and considered it a great source of information. I have to admit I was taken aback by your comment that Obama is a “centrist.” That is way way off track. Also, in your estimation, where are all Docs going to be coming from to treat the influx of all the new patients?

Roberts, along with Obama, has found his uncontested place in history books. He knew that the long journey to universal healthcare would eventually reach its destination, and now he knows that his name will forever be associated with the first major step toward that inevitability. Those opposed do not seem to realize that we are already paying for the uninsured (but inefficiently), that most Americans do not currently have choice in health care (insurance exchanges expand that in a market-based fashion), that free preventive care saves more than it costs, etc. I suspect that fee-for-service reimbursement is the next thing to go, replaced by some kind of payment bundling, ACO’s, etc. (and will eliminate waste and free up docs to provide meaningful value-based services for more people).

Obamacare is a disaster. How can any good come of a 2700 page law? Compassion may be a laudable emotion, but usually makes for poor legislation. Limousine Liberals, Mastercard Marxists, and Trustafarians simply have too much trust in central planning and the opinion of “experts”. Who exactly will serve on IPAB and decide what is to be covered and for whom?

Medicaid is a joke. No one will see all these patients. They may nominally be “insured” but they won’t actually have any care. And besides, the vast majority of outpatients are noncompliant with medications and thus the perceived benefits of “preventive care” are hugely overstated.

At least Roberts built up enough political capital to decide Fisher v Texas in favor of the plaintiff…

Bob, loved the column.
Struck by the comments that have been written. People…PLEASE get a grip…you articulate political garbage…half of the things you write/ edit/ re edit … I’m certain you don’t fully grasp. Remember the PATIENT and not your politics when pontificating about health care reform.

Having seen many changes in my 25 years in healthcare, I am not confident we will ever see meaningful changes in healthcare as it relates to everyone having adequate coverage and medical care that doesn’t cost an arm and leg. Why the pessimism on the part? Answer this; How can you get all the major players in health care, pharma, insurance industry, hospitals, and physicians to the same table and agree upon anything? Afterall, they all have competing interests. BTW, who is at the table representing the pt?

Yes, but lets not forget the Churchill was a failed military strategist, responsible largely for the millions who perished in human wave attacks on Gallipoli eventually leading to his demotion and later resignation. Along the same lines we all too often see professionally incompetent individuals become politicians and ultimately prisoners of insurance companies and big pharma making decisions on our behalf.

Who wouldn’t love to be seen everywhere by their doc? I would love to continue doing that too, but ins. cos and big pharma along with politicians have been f-ing us for too long so we docs are responding by asking to have our lives back by becoming hospitalists and surgicalists. After all if our patients who are also voters fail to see the importance of the traditional doc, why should we continue to slave to them?

I am certain that as a hospitalist my family will see a lot more of me.